0:08Skip to 0 minutes and 8 secondsAngeliki Messina is the Quality Leadership Manager who was the project manager for this Netcare model. Angeliki, why was it important to have a dedicated project manager for this stewardship model? I think it was important, because there was such a significant number of sites. And so there needed to be someone dedicated to help support the implementation in each side, and also be there to provide real time feedback to all the hospitals, and keep an ear to the ground to see what work was happening at each site, so that he could share that amongst the group.

0:45Skip to 0 minutes and 45 secondsBut you think it's important that even if you applied this model of "low-hanging fruit" the basic interventions, even in one hospital, that there's somebody who coordinates it. It doesn't have to be a project manager per se, because of that reason. I think definitely, because sometimes the fact that you have to send a report to someone really helps you to be strict about your work consistent, make sure you collect accurate data, and know that someone is looking at it at the end really helps you to drive the work on the floor. Now, our learners in this quick win across the globe will have noted the six weekly learning cycles as part of the improvement model.

1:32Skip to 1 minute and 32 secondsWhat was your role in these learning cycles? Why you're teleconferencing, but, of course, if it was single hospital it would be an on-site group. So really, my role in those learning sessions was to share good work. So if you were in one hospital and you knew your one ward was performing well compared to another ward, you would then go and share those ideas that the good performing ward is doing, that maybe the other ward could implement to try and help improve their consumption of antibiotics or their prescribing practices, et cetera. So from a group perspective, in our telecons, we shared good stories of good work happening in some hospitals, that would get other sites to replicate their methodologies.

2:18Skip to 2 minutes and 18 secondsAnd our learners would have learned why it is absolutely crucial in stewardship to collect data in a standardised way. Why was it important for you to do it in a standardised template. So-- In principle --in our division, we have this mantra that says that we can't prove what we're doing if we don't collect the data. And so, standardising the data was really an important part of progressing our programme across all sites. Because what it did was, first, it taught our non-infectious disease trained pharmacist what data to collect, as well as how to collect the data.

2:56Skip to 2 minutes and 56 secondsAnd then, it gave them the opportunity to showcase their own hospital specific data to their stewardship committee meetings, and that helps doctor engagement and buy in, to help progress the implementation of the programme further in their sites. And then, as our programme progressed, they were able to get ward specific data, which then they would be able to compare wards against each other, and get a hospital perspective for improvement going forward. Also, the collection of data helped the hospitals to identify their specific focus areas for improvement. So maybe one hospital was really struggling with more than four antibiotics at the same time, and another hospital was struggling with duration of therapy.

3:38Skip to 3 minutes and 38 secondsAnd so, collecting the data of the "low -hanging fruit" separately, for each hospital, helped identify their specific areas of improvement, and it wasn't just a blanket approach across all hospitals. Thank you, Angeliki. We'll be showing our learners what the standardised template could look like. Thank you. Thank you.

The importance of co-ordination

Watch the video with Ms Angeliki Messina, the Quality Leadership Project Manager for this South African AS initiative, as she explains the value of her role in co-ordinating data collection, feedback and the shared learning that could be gained through communication.

Ms Messina was appointed (initially) for two days a week to collate and support the implementation. Initial training was provided through face-to-face regional learning sessions with pharmacists representative of all hospitals, as well as to pharmacy managers, nurses and infection prevention practitioners (Learning session 1).

In line with the breakthrough series model, each pharmacist was then required to undertake an implementation process in their hospital including collection of data on a standardised template.

Following Learning session 1, conference calls were held every 6-8 weeks with pharmacists nationally, hosted by the executive sponsor and project manager (Learning session 2, 3, 4, 5 etc). In between the learning sessions support was provided by the project manager. In addition, doctor input was obtained during subsequent 12-monthly, face-to-face regional learning sessions.

As well as the appointment of an AS project manager, “protected” AS time was mandatory and enforced i.e. hospital and pharmacy managers supported pharmacists with time to conduct ward rounds which ranged from an hour a few times a week, to a few hours a day depending on the size of the hospital.

Submission of data for group-wide monitoring was encouraged at first and later made part of a performance management process. No financial incentives were offered. Abstract submission to and attendance at local infectious disease congress meetings were encouraged.